Published in Journal of Parenteral and Enteral Nutrition, October 2021
View online here
Can exclusively using enteral nutrition with a polymeric feed be useful as a way to induce remission in adults with active Crohn's Disease (CD)? Researchers in the Gold Coast Inflammatory Bowel Diseases Research Group (Australia) have just published this retrospective study addressing this very question, looking at the effectiveness of exclusive EN with an oral polymeric formula at inducing clinical and biochemical remission in 66 adults with active CD.
- Primary outcome was clinical remission (CDAI ≤150) or response (100-point decrease in CDAI) at 8 weeks.
- Secondary outcome was achieving biochemical remission (CRP ≤5 mg/L or faeces calprotectin ≤150 mcg/g) at 8 weeks in those whose baseline values were elevated.
Patients were under the supervision of a specialist IBD Dietitian, either as inpatients or outpatients. All patients were offered polymeric formulas containing 1.5-2.0 kcal/ml (Ensure Plus (Abbott), Resource Plus or Resource 2.0 (Nestle)) and the choice of supplements was based on patient preference, often with a mixture of supplements chosen to avoid taste fatigue.
Nutritional requirements were calculated by the dietitian in line with ESPEN guidelines for patients with active IBD (Protein 1.2-1.5g/kg/d and energy requirements varied from 100-145kJ/kg/day). In addition to the polymeric formula, patients were allowed to drink water but had to avoid all other foods and fluids. The polymeric formula gradually replaced meals and snacks over a period of 1-2 days.
Key findings were that:
▪️80% of patients completed the prescribed exclusive EN course and at 8 weeks, 64% of patients achieved the primary endpoint and 57% achieved the secondary endpoint
▪️Patients who received exclusive EN for ≥ 6 weeks achieved the primary (72% vs 47.8%, (OR 2.8, CI 0.97 -8.16, p = 0.047) and secondary outcomes (67.6% vs 36.8%, OR 3.58, CI 1.1- 11.63, p = 0.035) more frequently compared with those patients who received exclusive EN for <6 weeks.
▪️Only 9 patients reported adverse effects (nausea, diarrhoea, constipation, abdominal pain) but none of these patients stopped therapy. (13 patients had ceased therapy due to poor palatability (8 patients), taste fatigue (3 patients) and social or financial reasons (2 patients))
The authors concluded that using a polymeric feed taken orally (and exclusively), was ‘well tolerated, safe and effective in inducing clinical and biochemical remission in adults with active CD’. The retrospective study also indicated that exclusive enteral nutrition for ≥ 6 weeks had better outcomes.